equity of access to rehabilitation services in australia
TRANSCRIPT
University of WollongongResearch Online
Australian Health Services Research Institute Faculty of Business
2011
Equity of access to rehabilitation services inAustraliaFrances D. SimmondsUniversity of Wollongong, [email protected]
James P. DawberUniversity of Wollongong, [email protected]
Janette P. GreenUniversity of Wollongong, [email protected]
Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library:[email protected]
Publication DetailsF. D. Simmonds, J. P. Dawber & J. P. Green "Equity of access to rehabilitation services in Australia", ANZCOS / AFRM Conference,Brisbane, 15 September 2011, (2011)
Equity of access to rehabilitation services in Australia
AbstractPowerpoint presentation presented at the ANZCOS / AFRM Conference, Brisbane
Keywordsservices, equity, rehabilitation, australia, access
Publication DetailsF. D. Simmonds, J. P. Dawber & J. P. Green "Equity of access to rehabilitation services in Australia", ANZCOS/ AFRM Conference, Brisbane, 15 September 2011, (2011)
This conference paper is available at Research Online: http://ro.uow.edu.au/ahsri/106
Equity of Access to h b l S Rehabilitation Services in
AustraliaAustralia
Frances SimmondsJ D bJames DawberJanette Green
A t l i R h bilit ti O t Australasian Rehabilitation Outcomes Centre (AROC)( )
• AROC is a joint initiative of the Australian rehabilitation sector established in 2002
• AROC manages a rehabilitation benchmarking i i i i i A li d N Z l d h initiative in Australia and New Zealand whose ultimate aim is the improvement of outcomes for rehabilitation patients rehabilitation patients.
• To achieve this, AROC requires member rehabilitation services to collect a defined set of rehabilitation services to collect a defined set of data against each and every rehabilitation patient they treat. patient they treat.
Introduction
• Explore the question, are rehabilitation services equally accessible across Australia?equally accessible across Australia?▫ Patients and facilitiesE l i f t hi h ff t lit• Exclusion factors which may affect equality:▫ Socioeconomic status
R l ▫ Rural or remote▫ Public vs. private rehabilitation service
M th dMethods• Inpatient data for the period 1 July 2009 to 30 June 2010• Inpatient data for the period 1 July 2009 to 30 June 2010.▫ 70,449 episodes▫ 165 facilities (of 180 nationwide)
• How were these exclusion factors measured?• Allocating a socioeconomic status category
• SEIFASEIFA
• Allocating a geographical location category
• ASGC-RA• Measuring distance
i b d• Trigonometry based on latitude/longitude of centre of postcodescentre of postcodes
Di ib i i i Distributions across socioeconomic and geographic levelsg g p
P l h id iPeople who reside in:• higher socioeconomic areas • Major Cities receive proportionally more rehabilitation.
National associations between socioeconomic and geographic levels
80%
90%
100%
socioeconomic and geographic levels
50%
60%
70%
80%
Major Cities of Australia
Inner Regional Australia
10%
20%
30%
40% Outer Regional Australia
Remote Australia
Very Remote Australia
0%
Low Medium High
Socioeconomic status
There is a clear relationship between socioeconomic status and remoteness, with lower socioeconomic areas being closely associated , g ywith regional/remote areas.
Distributions of socioeconomic level by public/privateby public/private
People who live in high socioeconomic areas are more likely to access private rehabilitation treatment.
Di t ib ti f f iliti Distribution of facilities across socioeconomic and geographic levels
25
30
35
40
cilities
Private rehabilitation facilities are more 5
10
15
20
25
Num
ber o
f fac
Public
Private
facilities are more likely to be found in high socioeconomic areas
0
5
Low (n=35, 16) Medium (n=29, 25) High (n=26, 34)
Facility scioeconomic status
areas.
And less likely to be f d l found in regional or remote areas.
Di ll d h bili i Distance travelled to rehabilitation services
70 90061.33
44.55
40
50
60
e (km
)
500
600
700
800
km)
Patientsocioeconomicstatus:
17.60
10
20
30
Distance
200
300
400
500
Distance (k
Low
Medium
High
0
Low (n=19674) Medium (n=19420) High (n=28975)
Patient socioeconomic status
0
100
Major Cities of Australia (n=53308)
Inner Regional Australia (n=11431)
Outer Regional Australia (n=2983)
Very/Remote Australia (n=348)
People residing in outer regional and remote high socioeconomic areas travel further to access rehabilitation than those in similarly located low socioeconomic further to access rehabilitation than those in similarly located low socioeconomic areas.
Distance travelled by impairment
99 17103.87
120
y p
40 48
62.01
51.00
99.17
60.92
43.63
53.98
90.59
60
80
100
tance (km)
40.4836.11 35.19
27.4133.39
14.079.97
19.6415.52
24.07
0
20
40Dis
For impairments treated largely in specialist units (e.g., brain and p g y p ( g ,spinal injury), the central locations of these services drives some of the differential in travel distance.
Additional information• LOS was different between socioeconomic
levels but is because of public/private levels but is because of public/private discrepancies
• No significant differences in FIM change g gbetween socioeconomic levels
• Average travel distance to access rehabilitation services varied considerably across different impairmentsA l di • Average travel distance to access rehabilitation services decreased as age increasedincreased
Conclusion• The main finding of the study is that access to
rehabilitation in Australia is inequitablePeople in lower socioeconomic areas▫ People in lower socioeconomic areas
▫ People in regional and remote areas• Access to public and private rehabilitation services p p
differ across socioeconomic and geographic locations▫ People residing in high socioeconomic areas are more ▫ People residing in high socioeconomic areas are more
likely to afford private rehabilitation services. ▫ Also, private rehabilitation services are more likely to
be situated in high socioeconomic areas which also be situated in high socioeconomic areas which also increases accessibility.